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Alabama High School Physical Form

The Alabama High School Physical form is a crucial document that ensures student-athletes are medically fit to participate in sports. This form requires detailed information about the athlete's medical history and a physical examination by a qualified physician. It serves as a safeguard for the health and safety of young athletes, allowing schools to verify that each student is ready to engage in physical activities.

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Alabama High School Physical Sample

ALABAMA HIGH SCHOOL ATHLETIC ASSOCIATION	Revised 2018
Revised 2018	Revised 2018
Preparticipation Physical Evaluation Form
History	Date_______________________

Name__________________________________________________ Sex ________ Age______ Date of birth _______________

Address ______________________________________________________________________ Phone______________________

School ________________________________________________________Grade __________ Sport ______________________

Explain “Yes” answers below:								Yes	No
1.	Has a doctor ever restricted/denied your participation in sports?
2.	Have you ever been hospitalized or spent a night in a hospital?
	Have ever had surgery?
3.	Do you have any ongoing medical conditions (like Diabetes or Asthma)?
4.	Are you presently taking any medications or pills (prescription or over‐the‐counter?
5.	Do you have any allergies (medicine, pollens, foods, bees or other stinging insects)?
6.	Have you ever passed out during or after exercise?
6.	Have you ever passed out during or after exercise?
	Have you ever been dizzy during or after exercise?
	Have you ever had chest pain or discomfort in your chest during or after exercise?
	Do you tire more quickly than your friends during exercise?
	Have you ever had high blood pressure?
	Have you ever been told that you have a heart murmur, high cholesterol, or heart infection?
	Have you ever had racing of your heart or skipped heartbeats?
	Has anyone in your family died of heart problems or a sudden death before age 50?
	Does anyone in your family have a heart condition?
	Has a doctor ever ordered a test on your heart (EKG, echocardiogram)?
7.	Do you have any skin problems (itching, rashes, staph, MRSA, acne)?
8.	Have you ever had a head injury or concussion?
	Have you ever been knocked out or unconscious?
	Have you ever had a seizure?
	Have you ever had a stinger, burner, pinched nerve, or loss of feeling or weakness in your arms or legs?
9.	Have you ever had heat or muscle cramps?
	Have you ever been dizzy or passed out in the heat?
10. Do you have trouble breathing or do you cough during or after activity?
	Do you take any medications for asthma (for instance, inhalers)?
11. Do you use any special equipment (pads, braces, neck rolls, mouth guard, eye guards, etc.)?
12. Have you had any problems with your eyes or vision?
	Do you wear glasses or contacts or protective eye wear?
13. Have you had any other medical problems (infectious mononucleosis, diabetes, infectious diseases, etc.)?
14. Have you had a medical problem or injury since your last evaluation?
15. Have you ever been told you have sickle cell trait?
	Has anyone in your family had sickle cell disease or sickle cell trait?
16. Have you ever sprained/strained, dislocated, fractured, broken or had repeated swelling or other
	injuries of any bones or joints?
	Head	Back	Shoulder	Forearm	Hand	Hip	Knee	Ankle
	Neck	Chest	Elbow	Wrist	Finger	Thigh	Shin	Foot

17.When was your first menstrual period?__________________________________________________________________

When was your last menstrual period?___________________________________________________________________

What was the longest time between your periods last year?________________________________________________

Explain “Yes” answers:

______________________________________________________________________________________________________________

I hereby state that, to the best of my knowledge, my answers to the above questions are correct.

Signature of athlete ___________________________________________________________ Date ___________________

Signature of parent/guardian __________________________________________________

FORM 5

DUPLICATE AS NEEDED

Rev. 2018 (The revised 2018 form is the official form accepted by the AHSAA.)

Page 1 of 2

Preparticipation Physical Evaluation Rule 1, Sec. 14 — In order for a student to be eligible for interscholastic athletics, there must be

on file in the Superintendent’s or Principal’s office a current physician’s statement certifying that

__________________________________________ the student has passed a physical exam, and that in the opinion of the examining physician (M.D.

			Student's name		or D.O.) the student is fully able to participate in interscholastic athletics (Grade s 7‐12). The
			Student's name		AHSAA Physicians Certificate (Form 5 Rev. 2018) must be used. A physical exam will satisfy the

Physical Examination					requirement for one calendar year through the end of the month from the date of the exam. For
Physical Examination					example, a physical given on May 5, 2019, will satisfy the requirement through May 31, 2020.

			Height ____________ Weight _____________ BP _____ / _____ Pulse ____________
			Vision R 20 / ____ L 20 / ____ Corrected: Y N			Revised 2018
			Vision R 20 / ____ L 20 / ____ Corrected: Y N

		LIMITED		Normal		Abnormal Findings

			Cardiovascular
			Cardiovascular

			Pulses

			Heart

			Lungs

			Skin

			E.N.T.

	COMPLETE		Abdominal

			Genitalia (males)
			Genitalia (males)

			Musculoskeletal

			Neck

			Shoulder

			Elbow

			Wrist

			Hand

			Back

			Knee

			Ankle

			Foot

			Other

Clearance:

A.Cleared

B.Cleared after completing evaluation/rehabilitation for: _______________________________________

C. Not cleared for:	Collision
	Contact
	Noncontact ____ Strenuous	____ Moderately strenuous	____ Nonstrenuous

Due to: ____________________________________________________________________________________________

Recommendation: _________________________________________________________________________________________

________________________________________________________________________________________________________

Name of physician ________________________________________________________________ Date ____________________

Address ________________________________________________________________________ Phone___________________

Signature of physician _____________________________________________________________, M.D. or D.O.

(Form must be signed and dated by the attending physician.)

Rev. 2018 (The revised 2018 form is the official form accepted by the AHSAA.)

⇓ PDF File

Instructions on Utilizing Alabama High School Physical

Completing the Alabama High School Physical form is a straightforward process that ensures students are ready for athletic participation. This form requires personal information, medical history, and a physical examination by a qualified physician. Follow these steps to fill out the form correctly.

Gather necessary information: Collect your personal details, including your name, sex, age, address, school, and grade.
Complete the medical history section: Answer questions regarding past injuries, medical conditions, and any medications you are currently taking. Be honest and thorough.
Provide details about your doctor: Fill in the name, address, and phone number of your physician who will perform the physical exam.
Sign the form: Both the athlete and a parent or guardian must sign the form to verify that the information provided is accurate.
Schedule the physical exam: Arrange an appointment with your physician to have the physical examination completed.
Submit the form: After the exam, ensure the physician completes the evaluation section and returns the signed form to your school’s office.

Once you have filled out the form and submitted it, your school will keep it on file to confirm your eligibility for participating in sports. It’s essential to ensure that all sections are completed accurately to avoid any delays in your athletic involvement.

Misconceptions

Understanding the Alabama High School Physical form is crucial for students, parents, and coaches. However, several misconceptions can lead to confusion. Here are eight common misunderstandings about the form:

Only athletes need a physical exam. Many believe that only students who plan to play sports need to complete this form. In reality, it is required for all students participating in interscholastic athletics, regardless of their level of involvement.
A physical exam is valid indefinitely. Some people think that once a student passes a physical, it remains valid for life. However, the form is only valid for one calendar year from the date of the exam. After that, a new physical is necessary.
Any doctor can complete the form. While it may seem that any physician can sign off on the physical, the form specifically requires a licensed medical doctor (M.D.) or doctor of osteopathy (D.O.) to ensure the evaluation meets the necessary standards.
Parents can fill out the form without any medical input. Some assume that parents can simply complete the form based on their knowledge of their child's health. However, a physical examination by a qualified physician is essential for the form to be valid.
The form is only about physical health. Many think the evaluation focuses solely on physical fitness. In fact, it also addresses medical history, including any past injuries or conditions that could affect participation in sports.
Students can participate in sports without submitting the form. It is a common belief that students can start practicing or playing without having the form on file. However, the Alabama High School Athletic Association mandates that the form be submitted before any participation.
All physical exams are the same. Some people think that any physical exam will suffice. The Alabama High School Physical form has specific requirements and must be completed in its entirety to be accepted.
Only serious injuries need to be reported. There is a misconception that only major injuries or health issues need to be disclosed. However, it is important to report all relevant medical history, as even minor issues can impact athletic performance and safety.

By addressing these misconceptions, students and parents can better navigate the requirements of the Alabama High School Physical form, ensuring that all necessary steps are taken for safe participation in athletics.

Documents used along the form

When preparing for athletic participation in Alabama high schools, several important documents work in tandem with the Alabama High School Physical form. These forms help ensure that student-athletes are fit for competition and provide necessary medical information. Below are some commonly used documents that you may encounter.

AHSAA Physician's Certificate (Form 5): This form is essential for confirming that a student has passed a physical examination. It requires a physician's signature and serves as proof that the athlete is cleared to participate in sports. The certificate must be kept on file at the school.
Emergency Contact Form: This document collects vital information about whom to contact in case of an emergency. It includes details like the athlete’s primary physician, emergency contacts, and any specific medical conditions that responders should be aware of.
Concussion Awareness Form: This form educates athletes and their parents about the risks associated with concussions. It requires signatures from both the athlete and a parent or guardian, acknowledging that they understand the symptoms and protocols related to concussion management.
Durable Power of Attorney: This legal document allows a designated individual to manage your affairs during incapacitation, ensuring that your preferences are followed. For more information, visit the Durable Power of Attorney website.
Insurance Verification Form: This document confirms that the athlete has adequate health insurance coverage. It may ask for details about the insurance provider and policy number to ensure that any medical expenses incurred during sports activities are covered.

Each of these documents plays a crucial role in safeguarding the health and safety of student-athletes. They help schools manage risks and ensure that athletes are well-prepared for their sports activities. Always check with your school’s athletic department for any specific requirements related to these forms.